title: Primary angioplasty in patient with ST-segment elevation myocardial infarction in the setting of intentional carbon monoxide poisoning.
abstract: BACKGROUND
  ST-segment elevation myocardial infarction (STEMI) due to coronary artery occlusion in the setting of acute carbon monoxide (CO) poisoning is a very rare presentation.
  
  
  OBJECTIVE
  Our aim was to report on the use of primary angioplasty in a patient with STEMI in the setting of CO poisoning.
  
  
  METHODS
  A 36-year-old man with retrosternal chest pain was admitted after exposure to CO. The initial electrocardiogram (ECG) showed ST depression in I, aVL, and V3-V4 with slight ST elevation in II, III, aVF leads. Toxic carboxyhemoglobin level of 22% and troponin I of 2.19 μg/L were confirmed. After oxygen therapy the chest pain diminished, but after about 15 h it returned. The repeat ECG revealed normalization of previous ST depression with persistent ST elevation in II, III, aVF leads. The troponin I concentration was 5.94 μg/L. An echocardiogram demonstrated an apex hypokinesia involving the adjacent segments of the anterior and lateral wall. On the coronary angiogram, an acute occlusion of the distal left anterior descending coronary artery was confirmed. Primary percutaneous coronary intervention (PCI) of the infarct-related artery was performed. After PCI, the patient was symptom free and had partial ST-segment elevation resolution. The patient was discharged home after 7 days, with persistent ST-T changes and mild hypokinesia of the apex suggesting myocardial injury.
  
  
  CONCLUSIONS
  Patients with toxic CO exposure who have symptoms of STEMI should be carefully evaluated with serial ECG, cardiac necrosis marker measurements, and an echocardiogram. When there is evidence of myocardial injury, a wider use of coronary angiography can identify patients who could benefit from PCI.
authors.affiliation: 2(nd) Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Dziewierz
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Ciszowski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Gawlikowski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.forename: Paweł
authors.initials: P
authors.lastname: Kleczyński
authors.forename: Andrzej
authors.initials: A
authors.lastname: Surdacki
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D002249:Carbon Monoxide Poisoning / Q000150:complications*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy*; D013406:Suicide, Attempted; D016896:Treatment Outcome
keywords: acute myocardial infarction; acute poisoning; angioplasty; carbon monoxide; left ventricular dysfunction